In an mortifying display of political cluelessness, Sen. Marco Rubio (R-Fla.) yesterday pronounced on the topic of Obamacare: “We have missed a golden opportunity to do something about it. But we haven’t given up the fight. The one thing I want people to understand is: They should not feel depressed about this or discouraged about the long term of it. We are going to prevail on this issue. It is just a matter of time. We will prevail because Obamacare is going to be a disaster. And it won’t be long before many people in this town will be scrambling to try to fix it.” Thunk. This was the argument for keeping the focus directly on the Obamacare rollout and structural flaws instead of the shutdown and debt ceiling.
Maybe it is not too late, however, despite the Republicans’ unnecessary loss, for the GOP to shine the spotlight on Obamacare, convince the public that this is an irreversible mess and compel its delay and even reworking. Republicans should give Rep. Paul Ryan (R-Wis.) the chance to scrape together a micro-bargain on a few items in the budget while the party engages in a nonstop campaign against Obamacare with an eye toward 2014.
The Post reports: “Health and Human Services predicted 500,000 people would enroll in health coverage this month, according to an internal memo obtained by the Associated Press. . . . Achieving that milestone looks, at this point, unlikely.” It sure does, because “state-run marketplaces have recorded just about 150,000 people turning in applications for health coverage. That’s around one-third of the coverage that the administration hoped to see by the end of this month.”
The problem isn’t merely a few stray computer problems. USA Today reports, “The federal health care exchange was built using 10-year-old technology that may require constant fixes and updates for the next six months and the eventual overhaul of the entire system, technology experts told USA TODAY.” The report quotes an information technology executive as warning, “The application could be fundamentally flawed. They may be using 1990s technology in 2.0 world.” The result is a frustrating, time-consuming ordeal for most users: “Recent changes have made the exchanges easier to use, but they still require clearing the computer’s cache several times, stopping a pop-up blocker, talking to people via Web chat who suggest waiting until the server is not busy, opening links in new windows and clicking on every available possibility on a page in the hopes of not receiving an error message. With those changes, it took one hour to navigate the HealthCare.gov enrollment process Wednesday.”
In a wide-ranging examination of the computer issues, healthcare guru Yuval Levin finds that the agency running the exchanges “did not hire a general contractor to manage the exchange project but handled that overall technical management task itself. . . [I]t was a very bad idea and was at the core of the disaster they have so far experienced.” The problems range from the cumbersome system requiring purchasers to first create an account before shopping for plans to the flawed subsidy calculations. (“It’s pretty clear that some actual consumers have made actual purchases with bad information, which will become apparent to them when they get their first bills.”) And then it seems the exchanges don’t interface with insurance companies. Only four state-run exchanges are properly working. The result is a problem that goes to the heart of the entire undertaking:
People who are highly motivated to get coverage in a community-rated insurance system are very likely to be in bad health. The healthy young man who sees an ad for his state exchange during a baseball game and loads up the site to get coverage—the dream consumer so essential to the design of the exchange system—will not keep trying 25 times over a week if the site is not working. The person with high health costs and no insurance will. The exchange system is designed to enable that sick person to get coverage, of course, but it can only do that if the healthy person does too.
But that is not the only set of problems. If you manage to get through to look at the insurance options, the sticker shock is striking, upsetting the conviction (held by both liberal advocates and conservative opponents) that the Obamacare deal was so attractive that Americans would get “hooked” on the benefits and then rise up in fury if they were curtailed. It might be that this is a rotten deal only liberal welfare staters could impose on the country.
First, there are millions of uninsured at or below the poverty line for whom subsidies are not available or for whom the Obamacare gold-plated insurance is too costly. Then there are the stories like this one:
Andy Mangione, who lives in Louisville, Ky., with his wife Amy and their two boys, is doing the same thing millions of people are doing — trying to figure out how much his insurance will cost under ObamaCare. Before the exchanges opened, his insurance company said his rates would soar. But now that there are subsidies, he’s been trying for days to find out how much he would get.
“To logically compare plans, I’ve been calling them every day since October 1st,” says Mangione, “several times a day on some occasions. Sometimes enduring 45, 50 minute holds, half an hour holds.” Although Kentucky officials were unable to give him a firm number on his subsidy because of repeated IT problems, they did refer him to a Kaiser Family Foundation site, which suggests his subsidy will be $414 a month — on a premium of $868. “What I’m concerned about is our doctor visits, our emergency room visits, and what I’m paying in my premium,” says Mangione. The problem is the plan closest to what he has now will mean a 24 percent increase over his current payment — after subsidies. And his co-pay for emergency room visits almost tripled — from $125 to $350 — an important factor for a family with two young boys.
That doesn’t even get to the young, healthy people who would rather self-insure, just as they have been doing all along.
With some direction from leadership, Republicans previously at each other’s throats can unite around the common goal of showing why Obamacare is untenable. They’ve made the philosophic and economic arguments but now they have the goods, the evidence. That — and the Ryan negotiations — should occupy the lion’s share of Congress’s time until the end of the year.
Republicans need to have at the very least a proposal to help those for whom Obamacare is unaffordable. They can start with a proposal to allow individuals to escape the insurance that they’re being told they must have and is more expensive than their existing insurance. The promise of Obamacare — keep your insurance if you have it — wasn’t “lose your coverage and pay more.” Republicans should be the heroes of the lower- and middle-class Americans who are being punished by a horribly designed program. (And if sign-ups stay low, the subsidy from healthy young people to poorer, older people will only worsen.)
And for those uninsured Americans at or below the poverty line, Republicans should propose that in exchange for states covering individuals up to the poverty line (or higher), the feds would give governors waivers to reduce costs, fight fraud and provide better coverage for less. Reform Medicaid before you expand it. Let the Democrats insist that people who can’t afford the Affordable Care Act must sign up or be fined. Let the Democrats be the ones to refuse to improve the Medicaid program.
It would be nice if Republicans had thought strategically before embarking on the idiotic shutdown gambit, if leadership had a six-month or one-year plan for taking out Obamacare and tackling the debt, if the GOP had used its governors to highlight the Obamacare misery inflicted on the public, and if the contrast had been made between right-wingers urging political suicide (from the safety of their think tanks and political action committees) and the smart, capable lawmakers who make the case against Obamacare while offering voters something better.
The good news is that it’s not too late. The facts favor the Republicans; Democrats should be defensive and scrambling to clean up their mess. The way one beats the Dems and saps the strength of the destructive right wing is by filling the political vacuum with good policy, smartly offered and relentlessly repeated. It sure beats the catastrophe of the last few weeks.